Elderly patients let down by 'culture of failure' in hospitals

McNeil made the outspoken attack on the standards of care in Scottish hospitals after examining a series of reports produced by watchdog body Healthcare Improvement Scotland (HIS), while carrying out a programme of announced inspections focusing on care for older people in hospital wards.

His analysis revealed similar problems in hospital after hospital, including a failure to screen for brain conditions such as dementia and to draw up care plans for patients with this type of condition, also known as cognitive impairment.

It also highlighted alarming failures in ensuring elderly patients are sufficiently fed and hydrated, with issues being reported including nutritional assessments not always being carried out, patients not always being referred to a dietician and patients and staff not having access to equipment or utensils to help with eating.

McNeil, the Labour MSP for Greenock and Inverclyde, said: "The same issues are coming up again and again and the systems that are supposed to be in place – assessments and care plans – are not in place and not being actioned or monitored.

"We have also got to bear in mind that these are announced inspections. When you see the reports together there are clear trends here, which simply should be ringing alarm bells."

McNeil argued that hospitals were generally geared up to deal with patients who "fit the norm", but were not always able to cope with those suffering from dementia or a brain impairment.

"Each of these reports contain shocking individual stories, but more importantly when you bring them together, it looks like we have got a serious problem in the acute hospitals trying to manage and prioritise elderly and vulnerable people alongside everything else they deal with," he said.

"It looks like, under that sort of pressure, it is the elderly and the vulnerable who are losing out."

He also raised concerns over inconsistencies between the self-assessments conducted by health boards and the findings of the inspections. For example, while a Greater Glasgow and Clyde health board document stated that patients with brain conditions could be referred to specialist mental services, the staff caring for them were unaware that this was available.

The inspection reports on dementia care have so far covered the Western Infirmary, Royal Alexandra Hospital and Glasgow Royal Infirmary in NHS Greater Glasgow and Clyde, the Western General in NHS Lothian and Hairmyres Hospital and Wishaw General in NHS Lanarkshire.

Problems highlighted included a lack of stimulation for patients with dementia and brain conditions at four hospitals: the Western Infirmary, Western General, Hairmyres and Glasgow Royal Infirmary.

A lack of systems to keep track of patients with cognitive impairment, who may suffer from confusion and disorientation in unfamiliar surroundings, was also identified at the Western Infirmary, Western General, Hairmyres and Wishaw General.

Three hospitals – the Western General, Western Infirmary and Wishaw General – were also inspected on the nutritional care and hydration of older patients.

Issues highlighted included insufficient information in patients' records about what help they might need with eating and drinking and a lack of appropriate equipment, such as scales to weigh patients.

A spokesman for charity Age Scotland called for an investigation into the failings in order to produce a series of "clear recommendations" for action.

He said: "From the recent run of inspections by Healthcare Improvement Scotland a picture is beginning to emerge of NHS staff who, by and large, provide a good quality of care, yet with too many corners cut.

"Recurring incidences of incomplete records, inadequate screening and failure to fully comply with agreed procedures are worrying."

Jim Pearson, deputy director of policy at Alzheimer Scotland, said the organisation had highlighted such issues for years and provided funding, together with the Scottish Government, for NHS boards to appoint specialist nurse consultants to tackle such issues.

He added: "We are deeply disappointed that these common issues and problems are not yet eradicated from all of our acute care environments.

"The size and scale of the number of people with dementia in acute care is only going to increase; if we fail to get the basics right now, we will have serious problems in the future."

In the wake of the reports being published, the NHS boards involved said that action was being taken to address the problems highlighted by inspectors and pointed out the reports had also highlighted a number of positive areas of care.

In June it was announced inspectors would embark on a programme of unannounced swoops on hospitals to address concerns over the treatment of elderly and infirm patients.

HIS said the hospitals were identified for inspection through a risk profile compiled by gathering various data, but declined to give details of the number of unannounced inspections which would be carried out as it would "not benefit the process".

A spokesman for HIS said: "Identifying key themes is an important part of our inspection programme to improve the care of older people in acute hospitals in Scotland.

"With this in mind, we will be producing regular reports for the Scottish Government that will focus on those themes that we see emerging from our inspections.

"Moreover, the key findings emerging from the inspections will inform a national programme to improve care for older people.

"This way, learning from individual hospitals will benefit the NHS in Scotland as a whole."

A Scottish Government spokeswoman said action plans were being put in place by NHS boards following inspections to ensure necessary improvements were carried out.

She added: "We are pleased that unannounced as well as announced inspections have been introduced – put in place by this administration in February – and we are confident that they will help drive up standards of care of older people even further across Scotland.

"We are working in collaboration with NHS boards and a wide range of relevant bodies to identify national themes emerging from the inspection reports and to use this to inform policy at a national level."

THE VERDICT OF HEALTH INSPECTORS AND RELATIVES OF PATIENTS

"I have found that my father is not kept informed of his treatment - On one visit we were appalled to find him sitting on his bed naked in his own urine with no screens around him and this was during visiting hours. I did raise my complaint with the ward sister but still no update after three weeks. Some staff are rude and only pay lip service to any questions."

Relative of patient, Wishaw General

"While speaking to us, a member of nursing staff referred to patients using inappropriate language such as 'grabbers', 'criers' and 'feeders'. Several members of staff also referred to bed rails on adult beds as 'cot sides'."

HIS inspector, Royal Alexandra Hospital

"We saw a patient who had been in the hospital for eight weeks. This patient was now medically fit for discharge, but was awaiting a place in a care home in the community. The patient had been assessed on numerous occasions as having a cognitive impairment, but had no access to any activities or stimulation in the hospital."

HIS inspector, Western Infirmary

"Staff were not always involving patients in conversations about their care and treatment, for example talking over patients (she needs her toenails cut). We observed staff talking to other patients or staff whilst undertaking tasks such as putting disposable aprons on other patients before mealtimes. We also observed staff talking about other patients' conditions and treatment whilst undertaking tasks in the bay areas such as making patient beds. ... A nurse interrupted a healthcare assistant who was speaking with and providing comfort to a patient who was visibly upset."

HIS inspector, Wishaw General

"We noted that some wards and departments did not have equipment to weigh patients who were unable to sit or stand independently."

HIS inspector, Western General

"We noted that one patient had lost almost 5kg in weight over a period of three weeks in hospital. It was not clear from the patient's health record whether the dietitian or a speech and language therapist had reviewed the patient during this time. Speech and language therapists carry out assessments to see whether a patient has any swallowing difficulties. Neither the senior charge nurse nor the staff nurse looking after the patient were aware of the patient's weight loss. They told us that staff had recently discouraged the patient's family from bringing in food for the patient during visiting time."

HIS inspector, Western General

"On another ward, a patient required assistance to eat their meal. The patient had a previous diagnosis of dementia and a certificate of incapacity was present in their health record. The patient's meal had been left on the over-bed table, and the table had been pushed out of reach of the patient. A nurse then approached the patient, stood over her and gave her a spoonful of soup. The nurse then left the patient. When she returned, the patient stated she did not want any more soup. The patient was then asked if she wanted any dessert, but the nurse walked away before the patient responded. When the nurse returned, the patient then tried to eat a forkful of food by herself. The nurse offered no words of encouragement during this time and stood over the patient with her arms folded ..."

HIS inspector, Western General